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At least 631 records · Page 35Linked to original sources
PubMed1999

Compliance and functional residual capacity after staple versus combined staple/holmium laser lung volume reduction surgery in a rabbit emphysema model.

BACKGROUND: There is some evidence to suggest that laser exposure, when added to standard staple reduction techniques, may result in improved physiologic response to lung volume reduction surgery (LVRS). In this study, we compared physiologic responses of staple LVRS with combined staple/laser in a rabbit emphysema model. METHODS: Ninety-three New Zealand White rabbits underwent emphysema induction with aerosolized elastase 4 weeks before surgery and were killed 1 week after surgery. Treatment groups were bilateral moderate volume staple LVRS (< or =3 g, n = 39), combined moderate volume staple (< or =3 g)/holmium laser LVRS (n = 18), large-volume staple LVRS (> or =3 g, n = 27), or sham surgery (n = 9). RESULTS: Decrease in postoperative static respiratory system compliance by combined moderate-volume staple/laser treatment (1.22 cc/cm H2O) was similar to large-volume staple resection (1.40 cc/cm H2O, p = 0.39), and superior to moderate staple resection (0.82 cc/cm H2O, p = 0.01) or sham surgery (0.09 cc/cm H2O, p = 0.0001). Functional residual capacity decrease was greater after combined moderate staple/laser resection (6.46 cc) than large-volume staple resection (4.52 cc, p = 0.33), moderate-volume staple resection (4.59 cc, p = 0.43), or sham surgery (4.10 cc, p = 0.29). Perioperative mortality was highest after laser/staple LVRS (22%, 4/18). CONCLUSIONS: In this rabbit model, combined staple/ holmium laser reduction for emphysema results in significant improvement in compliance and trends toward improvement in functional residual capacity above staple reduction alone, but with higher mortality.

Animals↗
PubMed2000

Randomized clinical trial of sutured versus stapled closed haemorrhoidectomy.

BACKGROUND: Stapled haemorrhoidectomy does not involve dissection, with its attendant potential morbidity, required to perform closed haemorrhoidectomy. This study compared haemorrhoidectomy with (sutured) and without (stapled) preliminary dissection. METHODS: Forty patients with prolapsed symptomatic haemorrhoids were randomly assigned to sutured (n = 20) or stapled (n = 20) haemorrhoidectomy. Preoperative assessment was by proctoscopy, sigmoidoscopy and anal manometry. Stapled and diathermy haemorrhoidectomies with wound suture were performed, and excised tissue was examined histologically. Pain scores, complications, wound healing and patient satisfaction were recorded. Follow-up was weekly for 4 weeks, and at 3 and 6 months; anal manometry was repeated at the last two visits. RESULTS: Postoperative resting and squeeze pressures were reduced by the stapled method at 3 months (P = 0.02 and P = 0.03 respectively), returning to baseline by 6 months. Stapled haemorrhoidectomy was quicker but initial access into the anus was hampered by the bulky stapler. Isolated muscle fibres were identified equally in both groups, but incontinence did not occur. The stapled technique resulted in less postoperative pain (P = 0.04), a greater degree of satisfaction (P = 0.01) and faster wound healing (P < 0.001), but was more expensive. There was no significant difference in complications. CONCLUSION: Despite the higher cost and difficult access, stapled haemorhoidectomy results in less postoperative pain, faster wound healing and greater patient satisfaction than the sutured technique.

Adult↗
PubMed2002

Spontaneous pneumothorax resulting from congenital cystic adenomatoid malformation in a pre-term infant: case report and literature review.

In the literature there are only three reported cases of spontaneous pneumothorax resulting from congenital cystic adenomatoid malformation in children under 1 year and for whom any resuscitative efforts were made. We present here a fourth case of a pre-term baby girl who was in perfect health, until she suffered a spontaneous pneumothorax as the initial manifestation of congenital cystic adenomatoid malformation of the lung at 10 weeks of age. Atypical segmentectomy with the use of stapling devices was successful. The characteristics of this particular manifestation are discussed.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed1996

The use of T-bars in laparoscopic ventral hernia repair.

During the past 2 years 15 laparoscopic ventral hernias have been performed at our Community Hospital. Marlex mesh has been the material used. We have noticed some difficulty with the grasping and initial anchoring of the mesh. Percutaneously placed prolene sutures allow the mesh to be drawn upward with some effort. By using laparoscopic T-bars for the initial anchoring of the mesh to the anterior abdominal wall then stapling, the operative time was greatly reduced. This modification in technique allows for quicker placement of the mesh during the repair.

Abdominal Muscles↗
PubMed2000

Stapled versus sutured closure of loop ileostomy: a randomized controlled trial.

OBJECTIVE: To compare the outcome after conventional sutured loop ileostomy closure with stapled ileostomy closure. SUMMARY BACKGROUND DATA: A defunctioning loop ileostomy is now widely used in colorectal surgery. Subsequent closure may be associated with early complications, particularly bowel obstruction. The results of a preliminary nonrandomized study suggested that there was no significant difference in the rate of complications between sutured and stapled closure of loop ileostomy. METHODS: One hundred forty-one consecutive patients who underwent loop ileostomy between 1993 and 1998 were randomized before surgery to either sutured or stapled loop ileostomy closure. Seventy-one patients had stapled closure and 70 had sutured closure. RESULTS: Both groups were comparable in terms of age, sex, original operation, duration after original operation, and level of operating surgeon. Postoperative bowel obstruction occurred in 10/70 (14%) patients after sutured closure compared with 2/71 (3%) patients after stapled closure. Subgroup analysis of ileostomy closure in patients having an ileal pouch showed no significant difference in bowel obstruction between stapled and sutured closure (2/30 vs. 7/29). The incidence of other complications, readmissions, and reoperations did not differ between the two groups. The stapled closure was only 4 minutes quicker than sutured closure. The mean total hospital stay tended to be shorter after the stapled closure than the sutured closure, but this did not reach statistical significance. CONCLUSIONS: Bowel obstruction occurred less frequently after stapled closure, but the mean hospital stay and readmission and reoperation rate did not significantly differ between the two groups.

Adult↗
PubMed2005

Ambulatory circular stapled haemorrhoidectomy under local anaesthesia versus circular stapled haemorrhoidectomy under regional anaesthesia.

BACKGROUND: The usage of circular stapled haemorrhoidectomy (CSH) has increased dramatically in recent years. Hitherto this has been performed using regional or general anaesthesia. The present study assesses the feasibility of performing CSH under local anaesthesia on an ambulatory basis and its acceptance by patients. METHODS: Sixty patients with symptomatic third or fourth degree haemorrhoids were randomized into two groups. Group A patients had CSH under regional anaesthesia (i.e spinal anaesthesia) and were discharged the next day and group B patients had CSH under local anaesthesia and were discharged on the same admission day. Both groups were assessed by visual analogue pain score. In addition, group B patients were asked questions regarding their satisfaction with the procedure. RESULTS: No significant differences in pain score and analgesic requirement were found between the two groups of patients. All patients in group B except for one, reported that they were satisfied to highly satisfied with their procedure. CONCLUSIONS: Circular stapled haemorrhoidectomy can be performed safely under local anaesthesia in an ambulatory care setting. The potential cost savings that may accrue would offset the cost of the stapler.

Adolescent↗
PubMed1994

Rectal prolapse.

Marlex rectopexy is a popular and effective procedure for the repair of rectal prolapse. Heretofore, this operation has required a generous laparotomy. As videolaparoscopy provides superior pelvic exposure, performing a modified Ripstein procedure was a logical progression of minimally invasive surgery. Experience with the first sutured Marlex rectopexy suggested the need for a simple fixation device to secure the mesh to the sacrum. A commercially available orthopedic staple allows quick and secure fixation. Five cases of laparoscopic Marlex rectopexy provide our initial clinical experience. The LCR staple has reduced operating times by up to 1 h. Results in these cases show virtual complete repair of the prolapse, minimal postoperative analgesic requirements, and no postoperative incontinence. There was one postoperative complication requiring reoperation. There were no deaths. Laparoscopic stapled Marlex rectopexy is a promising modality for the treatment of procidentia.

Aged↗
PubMed1995

Cost analysis of stapling versus suturing for skin closure.

A randomized, prospective study was performed to test the null hypothesis that there is no difference between the cost of stapling and suturing for skin closure of selected linear lacerations. Appropriate wounds were randomly assigned to be closed by staples or sutures. Wound lengths, skin closure times, and the number of staples or the number and types of sutures used were recorded. Costs for materials and labor were calculated. The average total cost per case was $17.69 (with suture kit) and $7.84 (without suture kit) for the staple Group compared with $21.58 for the suture Group (P = .0001 for each). It is concluded that stapling is less costly than suturing and that the advantage appears to increase as laceration length increases.

Adult↗
PubMed1996

Laparoscopic transabdominal preperitoneal repair of a hernia of Morgagni.

A hernia of Morgagni was successfully repaired laparoscopically by reducing the hernia, mobilizing the peritoneum around the perimeter of the defect, and stapling polypropylene mesh onto the surrounding fascia. This type of repair is technically easy and should give a high probability of success.

Abdomen↗
PubMed1991

Thoracoscopic lung resection: use of a new endoscopic linear stapler.

Recent advances in rigid endoscopic imaging capabilities, light sources, and instrumentation have dramatically expanded the potential role of laparoscopic and thoracoscopic surgery. The recent introduction of an endoscopic linear stapling device has made possible thoracoscopic pulmonary resection. A 28-year-old woman with a history of recurrent pneumothorax, diffuse interstitial fibrosis, and left apical microblebs underwent thoracoscopic lung resection using this new stapling device. A 3 x 5 cm segment of involved lung tissue was removed. Postoperatively, the patient manifested no evidence of air leak and was discharged 48 h after surgery.

Adult↗
PubMed1994

Stapled typhlectomy via colotomy for treatment of cecal inversion in a dog.

A 13-year-old Weimaraner was examined because of chronic diarrhea, hematochezia, and moderate weight loss. Cecal inversion was diagnosed by use of colonoscopy. Exploratory surgery was performed, and the inverted cecum was exteriorized through a colotomy. Typhlectomy was performed by use of a stapling instrument that formed a full-thickness division of the cecum with a double row of staples on each side. This stapling technique provides a rapid, reliable method for treatment of cecal inversion when the cecum cannot be reduced manually.

Animals↗
PubMed2004

Total stapled, total intra-abdominal (TSTI) laparoscopic Roux-en-Y gastric bypass: one leak in 1000 cases.

BACKGROUND: Variations in technique of laparoscopic Roux-en-Y gastric bypass (LRYGBP) have been reported. These changes, mainly in the construction of the gastro-jejunostomy, are intended to decrease complications. METHODS: 1000 consecutive LRYGBPs were performed using the Total Stapled Total Intra-abdominal (TSTI) technique antecolic and antegastric approach. Technical details and results, including perioperative morbidity and mortality, are reported. RESULTS: Although the correction or improvement of the most serious co-morbidities with the use of the TSTI technique were similar to results reported by other gastric bypass surgeons, we noted a considerable difference in the development of leaks using this surgical approach. Current literature on gastric bypass reports a 2-5% incidence of leaks. Using the TSTI approach, the incidence of leaks at our facility was 0.1% (one in 1000 cases). After analysis of the factors involved, it was concluded that the use of the antecolic and antegastric approach in gastric bypass, as described in the TSTI,should be an important consideration by the surgeon. This technique, which uses a circular stapler, was found to be easy to perform while maintaining a reproducible, controlled opening of the anastomosis. CONCLUSION: Although this was a non-randomized study, the results found a considerable improvement in the incidence of morbidity and mortality, and a remarkable decrease in the frequency of leaks.

Anastomosis, Roux-en-Y↗
PubMed1994

Laparoscopic repair of a Morgagni hernia.

Laparoscopic repair of a diaphragmatic hernia through the right sternocostal foramen of Morgagni in an obese 42-year-old man is described. The indications for surgery were symptoms of strain-induced dyspnea and tightness in the chest. The technique was carried out by incorporating a marlex mesh into the defect and fixing it in place with hernia staples. The patient had an immediate recovery after repair of the hernia and has remained free of recurrence or complaints 9 months after surgery.

Adult↗
PubMed1998

Side-to-side stapled anastomosis may delay recurrence in Crohn's disease.

PURPOSE: Perianastomotic recurrence after resection in Crohn's disease may be related to ischemia and subacute obstruction at the anastomosis. A technique designed to minimize these factors currently is being evaluated. METHODS: From 1984 to 1997 69 patients underwent resection and primary anastomosis for symptomatic Crohn's disease (17 jejunal or ileal, 72 ileocolic, and 7 colocolic resections). Of these, 42 patients underwent functional end-to-end anastomoses with the use of linear cutting staplers (Proximate 75 mm or GIA 228 80 mm) and 27 patients underwent end-to-end sutured anastomoses. RESULTS: In the stapled anastomosis group one (2 percent) patient required reoperation for recurrent symptoms at 46 months. Complications occurred in four (8 percent) patients (one enterocutaneous fistula, one wound infection, one abscess, and one ileus). There were no anastomotic leaks. The median postoperative stay was seven (range, 5-26) days. In the sutured anastomosis group 14 (43 percent) patients required 15 further resections for symptomatic recurrence at a median of 46 (range, 4-91) months. Complications occurred in six (17 percent) patients (two anastomotic leaks, two fistulas, one stricture, and one pulmonary embolus). The median postoperative stay was 10 (range, 6-28) days. CONCLUSIONS: Functional end-to-end stapled anastomoses after resection for Crohn's disease may be associated with fewer complications than sutured anastomoses and may delay reoperation for symptomatic recurrence. Further evaluation of the technique is indicated.

Adolescent↗
PubMed2003

Laparoscopic distal gastrectomy with regional lymph node dissection for gastric cancer.

Recently, a minimally invasive operation for gastric malignancies has been advocated, and the laparoscopic operation is noted as a technique that increases the quality of life. We performed distal gastrectomy with regional lymph node dissection on 160 cases of gastric cancer located in the middle or lower third of the stomach. In 123 cases, Billroth I reconstruction was performed intracorporeally using the quadrilateral (square) stapling technique with a laparoscopic linear stapling device to prevent postoperative anastomotic bleeding and stenosis. In the remaining 37 cases, the Billroth II method was performed with a linear stapling device [1]. This technique is not only less invasive but also as safe as open gastrectomy, which was performed on 100 gastric cancer cases of similar staging.

Adult↗
PubMed1997

The best site for bronchial stapling in left and right upper lobectomies: a comparative study.

Bronchial stapling and postoperative bronchoscopy was performed in 22 left upper lobectomies (LUL) and 18 right upper lobectomies (RUL). Seven LUL cases and 15 RUL cases with staples positioned 2 bronchial rings (BR) from the entrance to the upper lobe bronchus (ULB) had no residual cartilaginous rings at the stump (RCRS). Deformity of the residual bronchus (DRB) was found in 6 of these 7 LUL cases, and 3 of these 15 RUL cases (p < 0.01), with a high rate of suffering from a severe cough. The remaining 15 LUL cases and 3 RUL cases had staples positioned 3 to 4 BR from the entrance to the ULB resulting in one or two RCRS. Only one LUL case with one RCRS was accompanied by DRB and coughing. These facts strongly imply a connection between cough and DRB. DRB was frequently seen in LUL cases with no RCRS (86%), was less likely to occur in cases with one RCRS (10%), and was absent in cases with two RCRS (p < 0.01). We conclude that bronchial staples applied during a LUL should be positioned 3 or 4 bronchial rings distal from the entrance to the left ULB.

Aged↗
PubMed1996

Comparison of staples vs suturing for securing central venous catheters.

OBJECTIVE: To determine whether skin staples can be used to secure central venous catheters as effectively as does suturing. METHODS: A prospective, randomized trial of techniques to secure a central venous catheter was performed in a medical school human anatomy laboratory using human cadavers. Central lines were secured to the upper left thorax using either standard suture material (000 silk) or skin staples (5.7 mm x 3.8 mm). Once secured, an upward force was applied to the hub of the catheter perpendicular to the skin. The amount of force needed to break the catheter hub free of the skin was measured in kg. A total of 10 measurements were made for each of 3 methods for securing the catheters (2 sutures, 2 staples, 4 staples). In addition, the site of catheter breakage was recorded. RESULTS: Those catheter hubs secured by 2 sutures required a mean force of 3.1 +/- 0.5 kg to cause breakage, and the break always occurred at the suture. Those hubs secured by 2 staples gave way at 3.0 +/- 0.3 kg (p = NS), while those secured with 4 staples gave way at 4.5 +/- 1.4 kg (p < 0.05). Although 1 hub did break, in all other stapled cases, the break occurred at the staple. CONCLUSIONS: Based on this cadaver model, use of staples appears to be as effective as suturing for securing central venous catheters. Further studies of safety and time for placement are needed.

Cadaver↗
PubMed2000

Stapling procedure for hemorrhoids versus conventional haemorrhoidectomy.

Forty patients admitted at the Saudi German Hospital were randomly assigned to Milligan-Morgan haemorrhoidectomy (n = 20) or the circular stapled procedure. Under general anesthesia patients underwent standardized haemorrhoidectomy or had a circumferential doughnut of rectal mucosa and submucosa above the dentate line excised and closed with a standard circular end to end stapling device. All patients received the same preoperative and postoperative analgesic and laxative regimens. Patients completed linear analogue pain charts each day and were interviewed at 1, 3, and 12 weeks postoperatively. Summary measures of average pain experience were calculated from 10 cm linear analogue pain scores and were used as the primary outcome measure. The stapled group was found to have shorter anesthesia time (9-25 minutes, median 18) versus (15-35 minutes, median 22). Average pain in the stapled group was significantly lower than it was in the Milligan-Morgan group (0.2-7.6, median 2.1) versus (3.1-8.5, median 6.5). Hospital stay and time to first bowel motion were not significantly different between both groups. Return to normal activity was significantly shorter in the stapled group (3-60 days, median 17) versus (14-90 days, median 34). Early and late complications, patient assessed symptom control, and functional outcome appear to be similar after short term follow up.

Hemorrhoids↗